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Gold Level Marketplace Plans

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Gold Level Marketplace Plans

The gold plan is one of four metal categories of insurance plans created by the Patient Protection and Affordable Care Act (ACA) and available through the healthcare marketplace. Gold plans, like all plans available on the healthcare exchanges, cover ten basic health benefits, including:

  • Ambulatory Services
  • Emergency Services
  • Laboratory Services
  • Prescription Drug Coverage
  • Hospitalization
  • Preventive Care
  • Maternity Care
  • Pediatric Services
  • Mental Health Services
  • Rehabilitative Services

While these are the basic services, insurance companies may offer more coverage on individual gold plans to make them more appealing to consumers.

Out-of-Pocket Expenses

Gold plans will generally cover 80% of the costs healthcare, plus whatever other benefits they offer. The remaining 20% of costs will be paid for by the beneficiary in out-of-pocket expenses. These figures are based on calculations of how much healthcare will be used by the entire pool of enrollees of a particular plan. Therefore, cost sharing for individual plans may vary.

Gold plans have a higher premium and lower deductible than most other plans offered on the marketplace. It is important to note, however, that under ACA, preventive care provided by doctors, hospitals, pharmacies and other healthcare providers is not subject to the deductible and must be paid for by the insurance plan. In addition, some insurers may exempt other costs from their deductible, like prescription drug coverage.

In order for an insurance company to offer plans on the marketplace, they must offer at least gold and silver plans. Whichever metal level of plan you decide on, be sure to study the Summary of Benefits and Coverage (SBC) for each plan carefully. The SBC provides cost sharing details in a standard format so that consumers can easily compare plans.

Need Help?  Contact RedQuote!

As we administer COBRA for the employers we work with, RedQuote helps beneficiaries compare their COBRA plan with numerous individual plan options to help them choose the best plan for their age, budget and coverage preferences. If your company might be interested in hiring us to offer these options to beneficiaries coming off your group medical plan, contact us today!

Published Oct 14, 2016.

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